Obstetric anaesthesia
SIA in Obstetrics at RUH
Structure of Module
The RUH maternity services have 45000- 5,000 deliveries /year, with an epidural rate of 24% and caesarean rate of 39%.
All obstetric activities occur in the Princess Anne Wing of the hospital and neonatal and obstetric services are closely aligned clinically and structurally, with a neonatal unit immediately next to the Bath Birthing Centre ( BBC) , which also links to the obstetric theatres in Princess Anne wing theatre suite. There is strong leadership and safety culture within the service which is rated as ‘Outstanding ‘ by CQC.
An elective caesarean list occurs daily Monday to Friday which is staffed separately by obstetric anaesthetic and theatre team to the emergency on call team, and a separate theatre is available for emergency cases.
Obstetric theatres have a TEG machine and Fibralga immediately available in theatres, as well as immediate availability of cell salvage. All anaesthetic assistants are trained in the use of both.
Obstetric clinics occur in the Antenatal clinic which is also close to the BBC and the maternity ward ( Mary) is on the first floor above the BBC
Sessions with the SIA
Clinical Specialist Obstetric sessions to include:
- Labour ward sessions : Labour ward handover and MDT ward round , emergency obstetric care with obstetric anaesthetic consultant. Follow up of all mothers receiving anaesthetic input progressing to leading ward round and management.
- Specific elective caesarean list– planning and management with consultant obstetric anaesthetist, progressing to manging solo.
- Attendance at Obstetric anaesthetic clinics with consultant anaesthetist, progressing to reviewing own patients .
- Specific follow high risk patients through pregnancy and involvement in caesarean birth if planned
- Regular attendance at High-risk obstetric clinic / shadowing maternal medicine physician. Developing MDT management plans for high-risk mothers.
- Fetal medicine clinic – run by Jo Fiquet , Consultant Obstetrician
- Opportunity to attend St Michaels Cardiac clinic on the 1st and 3rd Friday of the month. Clinic very popular so will need to organise well in advance if interested
Shadowing;
Opportunity to shadow multiple staff:
- Labour ward coordinator midwife
- Ocean team – manage mothers with PTSD and specific emotional requirements / learning difficulties
- Obstetric theatre coordinator
- Emergency obstetric registrar
- Obstetric registrar covering elective caesareans ( scrub in and assist)
- Neonatal team – morning ward round and at delivery in theatre when neonatal team required
Leadership and Governance
Regular 1:1 with obstetric anaesthetic lead.
- Triage of high-risk referrals and coordination of obstetric anaesthetic clinic appointments
- Review safety incidents / reports
- Participate in 72 hour review / patient safety incident Investigation
Arrange MDT maternity forum ( with obstetric educational registrar)
Advise some attendance at the following regular meetings which will be programmed into schedule:
- Matneo governance meeting – occurs monthly
- Labour ward forum- occurs monthly
- Anaesthetic representative on Maternity Safety Champions – chaired by Chief Nurse and NED
- Deteriorating mother group - bimonthly
- MDT Risk management meetings occur weekly and monthly – regular attendance when rota permits
Teaching
- Prompt 1 day training
- Opportunity to join Prompt faculty (Lead: Jess Murray , Quality and Education lead midwife) . Sessions occur monthly
- Maternal Critical Care training – annual course. Opportunity to help to facilitate and deliver sessions
- Facilitate midwifery critical care competencies
- Opportunity for tea trolley sessions on maternity unit for new initiatives and to reinforce training needs identified from patient safety events coordinating with the midwifery safety team and clinical educational facilitator
QI
Multiple opportunities for QI – specific mentoring from Lesley Jordan. Opportunities for early identification of deteriorating mothers, review obstetric analgesia effectiveness, sustainability projects.
Support service improvement and innovation opportunities with the obstetric MDT
We have an active midwifery research team who are also very supportive and opportunity to apply for OAA grants if have obstetric project.
Opportunity to attend comprehensive 4-day national QI training course delivered free at the trust- national accreditation and CPD
Presentation at local/ regional and national events
Secondment to tertiary centre
For more experience at a tertiary centre an observership at Queen Charlottes Hospital or alternative may be possible. If you are interested inform supervisor early so there is time to arrange.
SIA Lead – Dr Lesley Jordan